Kevin Kunkel PhD, MSPT, MLD-CDT

Male sex hormones

Androgens
Synthesis& secretion
Regulation
Pharmacological
actions
Anabolic steroids
Differ from androgens?
Preparations
Therapeutic uses
Adverse effects
Pharmacokinetics
Preparations
Therapeutic uses
Adverse effects
Anti-androgens
Danazole
Cyproterone acetate
Flutamide
Finasteride
Sildenafil
Androgens
- Includes
- Testosterone,
- Dihydrotestosterone (DHT)
- Androstenedione - Androstenedione
- Testosterone serves s
!rohor"one #or
Dihydrotestosterone (DHT)
estrdiol
Cholesterol
Pregnenolone
Progesterone
17-- Hydroxy
pregnenolone
17- Hydroxy
progesterone
Dehydro-epi
androsterone
Andro-
stenedione
Oestrone
Oestriol
TESTOSTERONE estradiol
Regulation of secretion
estrogen similar to Testosterone
Inhibin inhibits FSH secretion at A.P level
Testosterone & DHT
growth of genitals in a young male
production of sperm
growth of facial, pubic & axillary
hairs
Testosterone & DHT
muscular development
growth of larynx & voice deepens
inhibition of bone growth
Testosterone & DHT
thickening of skin, loss of
subcutaneous fat
behavioral changes in men
nitrogen retaining effect
erythropoietin secretion increased
Increased LDL & decreased HDL
Testosterone
Preparations
Dose
Testosterone aq.
suspension
50-100mg / 2 weeks
Testosterone
esters:
Testo. propionate
Testo.
phenylpropionate
Testo. cypionate
Testo. enanthoate
25-50 mg / 3 times a week
40-60mg / 1 or 2 week
100 200mg / 2 weeks
250 mg / 2 weeks
Testo. enanthoate
Orally active
preparations:
Methyl
testosterone tab.
Fluoxymesterone
Mesterolone
40mg/ day for 4-6 weeks
Transdermal
patches
2 patches /day
(back,abdomen,thigh)
Implants wall of abdomen/thigh
http://www.youtube.com/watch?v
=Fm8sPnii6ro
Pharmacokinetics
Absorption:
undergoes high first pass
metabolism
Therefore im in!ections or
synthetic preparations are
used
Transport: Transport:
highly protein bound
"etabolism:
by liver en#ymes :
androsterone &
etiocholanolone
e$cretion by urine
Clinical uses of testosterone
Testicular failure:
Primary % originates in the
testes
Secondary % originates in
the pituitary
&rectile Dysfunction
"enopause '(ot )lashes*
+hronic illness +hronic illness
(,-
.urns
/steoporosis
Clinical uses of testosterone
0ong term corticosteroid
therapy
/steoporosis
Decreased production 123
Pituitary d4arfism
+arcinoma of breast
(ereditary angioneurotic
oedema
Anemia 'refractory*
Adverse effects of testosterone
Virilization (female)
Feminizing side effects
(male)
Precocious puberty &
stunted growth
Cholestatic jaundice Cholestatic jaundice
Enlargement of
prostate
Atherosclerosis
Hepatic carcinoma
Edema
Anabolic steroids
Anabolic Steroids
Drug Preparation &
Dose
Methandienone 5 15 mg/day, p.o.
Nandrolone
phenylpropionate
10 50 mg/wk, i.m.
Nandrolone
decanoate
25 50 mg/3 wk,
i.m. decanoate i.m.
Stanozolol 2 - 6 mg/day, p.o.
Ethyloestrenol 8 - 16 mg/day, p.o.
Oxandrolone 5 10 mg/day, p.o.
Fluoxymesterone 5 10 mg/day, p.o.
Uses of anabolic steroids
/steoporosis
+atabolic states
Short stature
Anemia
'refractory*
Athletic
performance
Anti-androgens
Danazol
Cyproterone acetate
Flutamide
Finasteride
Danazol
Uses:
Endometriosis
Side effects:
Dose related
FSH & LH release in both sexes
Binding of steroids to receptors
Enzymes needed for steroid synthesis
Weak androgenic, anabolic, progestational & glucocorticoid action
Endometriosis
Menorrhagia
Fibrocystic breast disease
Hereditary angioneurotic
oedema
Gynecomastia
Infertility
Dose related
Amenorrhea (High doses)
Androgenic side effects
Cyproterone acetate
Block androgen receptors
secretion of gonadotropins
Uses:
Acne
Hirsutism
Ca. of prostate Ca. of prostate
Virilizing syndrome
Precocious puberty
Inappropriate sexual behavior
Male pattern of baldness
lutamide
5on6steroidal anti6
inflammatory
Antagoni#e androgens:
Accessory se$ organs
Pituitary
7ses: 7ses:
+ancer of prostate along 4ith
8nR(agonist
+ompetes 4ith Testosterone
and D(T to androgen
receptors
)emale hirusitism
Orally active
DHT levels
Benign prostatic
Finasteride (Proscar)
Prostate volume
Symptom score
Peak urine flow rate
5 reductase inhibitors
Enzyme that converts Testosterone
to DiHydroTestosterone (DHT)
Benign prostatic
hyperplasia
Peak urine flow rate
DHT level in
prostate
Side effects: Loss of libido & impotence in 5 % pts.
Also used for prevention of hair loss Dutastride (Avodart)
Parasympathetic
Sympathetic
Hypothalamus Hypothalamus Hypothalamus Hypothalamus
ANS ANS ANS ANS
Acetylcholine
Noradrenaline
Muscarinic Receptors
vasoconstriction
Penile flaccidity
Penile erection
Sildenafil
Inhi$its c%MP-S!eci#ic
!hos!hodiesterse ty! & (PD'&) in
the cor!us cvernos o# the !enis
'n(y"e !ro"otes de)redtion o# c%MP
*hich re)ultes $lood #lo* in the !enis
&+"), !,o, - h $e#ore se.ul ctivity &+"), !,o, - h $e#ore se.ul ctivity
!otentite nitrte/s hy!otension
ctivity
Side e##ects0
hedche, #lushin), dys!e!si,
"yl)i
emale sex hormones
&strogens
Synthesis & secretion
Regulation
Pharmacological actions
Pharmacokinetics
Preparations
Therapeutic uses
Progestrogens
Synthesis& secretion
Regulation
Pharmacological actions
Pharmacokinetics
Preparations
Therapeutic uses Therapeutic uses
Adverse effects
Anti6estrogens
+lomiphene citrate
+yclofenil
Tamo$ifencitrate
Ralo$ifene
/rmelo$ifene
Therapeutic uses
Adverse effects
Anti6progestrogens
"ifepristone
Cholesterol
Pregnenolone
Progesterone
17-- Hydroxy
pregnenolone
17- Hydroxy
progesterone
Dehydro-epi
androsterone
Andro-
stenedione
Oestrone
Oestriol
TESTOSTERONE
estradiol
Premenopausal : ovaries (10-100 g)
Postmenopasual :adipose tissue(2-10 g)
Pregnancy : placenta (up to 30mg)
Progesterone
Estrogen
LH FSH
!strogens
5atural
estrdiol
1estrone
1estriol
Synthetic
1.Steroidal
Ethinyl estradiol
Mestranol
Tibolone Tibolone
2.Non-steroidal
Diethylstilbesterol
Hexestrol
Dienestrol
Chlortrianisene
Pharmacokinetics
Absorption:
9ell absorbed by oral: parenteral &
transdermal admn
estradiol undergoes high first pass
metabolism Therefore other synthetic
preparations are more commonly used
estradiol esters im admn Slo4ly absorbed
& prolonged action & prolonged action
Transport: highly protein bound 'Se$
Steroid .inding 8lobulin 'SS.8*:albumin*
"etabolism:
by liver en#ymes
Significant entero6hepatic circulation
e$cretion by urine after con!ugation
!strogen "re"arations
/ral
+on!ugated estrogen
';<=>: 1=> mg tab: => mg in!*
&thinyl estradiol';;1: ;>:;1mg*
"estranol ';1 mg tab*
/esradiol succinate '1: = mg tab*
intramuscular
estradiol ben#oate '>: 1; mg in!* estradiol ben#oate '>: 1; mg in!*
,ntravenous
)osfestrol tetrasodium
'<; mg?ml in!: 1=; mg tab*
Topical
Dienestrol ;;13 vaginal cream
Transdermal
estradiol '=>:>; or 1;; mcg?=@ h*
estradiol A norethisterone
'>; mcg A ;=>mg*
estrogens# Actions
Sex organs:
vagina, uterus & fallopian
tubes
vaginal cornification
endometrium: proliferative
& secretary phase
menstruation
cervical secretion watery
Secondary sexual
characteristics:
Growth of breast
facial, pubic & axillary
hairs

estrogens# Actions
"etabolic &ffects
Anabolic effect '4eak*
)usion of epiphysis
Salt & 4ater retention
.P
,mpaired glucose tolerance
.lood coagulability
(D0 & 0D0 (D0 & 0D0
+holesterol content of bile
+arcinogenic Action
Adverse effects of Estrogen
Nausea, anorexia, vomiting, diarrhea
Libido, gynaecomastia & feminization (male)
Stunted growth
Adenocarcinoma of vagina & cervix ( offspring)
Postmenopausal : endometrial cancer Postmenopausal : endometrial cancer
Premenopausal : Ca. breast
Coronary & thrombo-embolic disorders
Gall stone
Benign hepatoma
LDL and HDL & TG, hyperglycaemia
Substitution therapy:
menopausal syndrome
Senile vaginitis
Clinical uses of estrogens
delayed puberty
as oral contraceptive steroids
Dysmenorrhea
Dysfunctional uterine
bleeding
Clinical uses of estrogens
Acne
hirsutism
/steoporosis
Prevention of heart attacks
Clinical uses of estrogens
+a of breast
+a of prostate
Postpartum lactation
Hormone $e"lacement Thera"%
2ene#its0
3elie# o# hot #lushes 4
vso"otor sy"!to"s
Crdio-!rotection
1steo!orosis
Al(hei"er/s disese
Dr*$cks0
endo"etril 4 $one
cncer
thro"$oe"$olic
diseses
Al(hei"er/s disese
Tibolone
1B6 norsteroidal drug
estrogenA progesterone A 4eak androgen
Preparation: =>mg tab,
7se: Hor"one 3e!lce"ent Ther!y 'menopausal symptoms:
urogenital atrophy: psychological symptoms: libido and osteoporosis
improved* improved*
Adverse Drug Reaction: 4eight gain: increased facial hair:
occasional vaginal spotting
+ontra,ndications: hormone dependent malignancy of breast:
uterus: undiagnosed vaginal bleeding: thromboembolic disease:
svere liver disease: migraine: epilepsy
Antiestrogens
Anti-estrogens
Clomiphene citrate
Cyclofenil
SERM
Tamoxifen citrate
Raloxifene
Ormeloxifene
Clomi"hene Citrate
5on6steroidal
.locks estrogenreceptor
"echanism:
8nR(& 8n release
7ses:
po % good absorption
tC: > % D days
adipose tissue
Side effects:
Polycystic ovary:
7ses:
Sterility
+a breast
,n vitro fertili#ation
"ale infertility
Polycystic ovary:
multiple pregnancy: hot
flashes: gastric
upset: vertigo:
dermatitis
Cyclofenil: similar to clomiphene but no peripheral
anti-estrogenic effects
Tamoxifen citrate
predominantly estrogenic &
partial anti6estrogenic action
proliferation of breast cancer
cells and endometrial cancer
Anti resorptive
8iven orally
"etabolised in liver to a
more potent @ /(6tamo$ifen
7ndergoes enterohepatic
circulation
7ses
Palliative therapy for
Anti resorptive
total cholesterol and 0D0
5o change in (D0 and T8s
risk of D-T & pulmonary
embolism
Palliative therapy for
advanced +A .reast
(ormonal treatment for both
early and advanced +A .reast
in 4omen of all ages
Adverse effects
(ot flushes: vaginal
discharge: cataract: nausea
Response rate:
ER +ve: 50%
ER & PR +ve: 60-70%
ER ve: 10%
Tamoxifen citrate
For 5 years :
Recurrence by 47 50%
Death 26 -28%
Contralateral Ca. breast 47%
Raloxifene
.one & +-S: partial agonist
&ndometrium& breast:
antagonist
Postmenopausal 4omen:
prevents bone loss
Reduce 0D0 cholesterol
<; mg tabE /rally absorbed
high first pass metabolism
Side effects: F fold increase in
deep vein thrombosis &
pulmonary embolism 'same
as estrogen(RT*
Reduce 0D0 cholesterol
<>3 reduction in risk of
breast cancer
5o increased risk of
endometrial cancer
5o relief of vasomotor
symptoms
Effective alternative to HRT
for prevention of and treatment
of osteoporosis
Ormeloxifene
&ndometrium& breast: antagonist
&$cessive bleeding 4ith anovulatory cycle at
menopause is regulari#ed
.ut vaginal epithelium & cervical mucus is not altered
7sed for treatment of D7.
<; mg tabE <; mg tabE
1=; mg t4ice a 4eek for =6F months
Side effects:
nausea: headache: fluid retention:
4t gain: rise in .P: prolonged menstrual cycle
Th%roid and Parath%roid Agents
and agents affecting bone
demineralization
Thyroid hor"ones Thyroid hor"ones 55 the $i) !icture the $i) !icture
'##ects o# thyroid hor"ones '##ects o# thyroid hor"ones
3e)ultion o# thyroid hor"ones 3e)ultion o# thyroid hor"ones
Synthesis o# thyroid hor"ones Synthesis o# thyroid hor"ones Synthesis o# thyroid hor"ones Synthesis o# thyroid hor"ones
Disese sttes resultin) #ro" thyroid Disese sttes resultin) #ro" thyroid
hor"ones nd their tret"ents hor"ones nd their tret"ents
Prthyroid hor"one nd clciu" Prthyroid hor"one nd clciu"
Axes Controlled &ia the Anterior Pituitar%
Hypothalamus Hypothalamus
Anterior Anterior
pituitary pituitary
Breast Breast
ACTH ACTH
Prolactin Prolactin
pituitary pituitary
Adrenal Adrenal
cortex cortex
Liver Liver
Bone Bone
Muscle Muscle
Thyroid Thyroid
Ovary Ovary
Testes Testes
ACTH ACTH
GH GH
TSH TSH
FSH/LH FSH/LH
$egulation of Hormone $elease
GHRH (+) GHRH (+) GH (+) GH (+)
(Somatotropin) (Somatotropin)
Liver and others Liver and others Somatomedin Somatomedin
(IGF (IGF--1) 1)
SOMATOSTATIN SOMATOSTATIN
((--))
GH ( GH (--)) Liver and others Liver and others
PIH (DOPAMINE) PIH (DOPAMINE) Prolactin ( Prolactin (--)) Breast Breast
Hypothalamus Pituitary Target Organ Hormone
PIH (DOPAMINE) PIH (DOPAMINE)
((--))
Prolactin ( Prolactin (--)) Breast Breast
PRH (+) PRH (+) Prolactin (+) Prolactin (+) Breast Breast
CRH (+) CRH (+) ACTH (+) ACTH (+) Adrenal Cortex Adrenal Cortex Glucocorticoid, Glucocorticoid,
mineralocorticoid mineralocorticoid
TRH (+) TRH (+) TSH (+) TSH (+) Thyroid Thyroid T3, T4 T3, T4
GNRH (+) GNRH (+) FSH (+) FSH (+)
LH (+) LH (+)
Gonads Gonads Estrogen, Estrogen,
progesterone, progesterone,
testosterone testosterone
Th%roid
Anto"ic !ro"inence6 one o# #irst endocrine Anto"ic !ro"inence6 one o# #irst endocrine
)lnds to $e correlted *ith clinicl condition )lnds to $e correlted *ith clinicl condition
cused $y "l#unction cused $y "l#unction
3eleses t*o ty!es o# hor"ones0 3eleses t*o ty!es o# hor"ones0
,,, , T T
FF
: : triiodothyronine triiodothyronine (7 iodine residues, (7 iodine residues,
&8 &89 iodine) 9 iodine) &8 &89 iodine) 9 iodine)
T
@
: : thyro$ine thyro$ine (: iodine (: iodine resideus resideus, ;& , ;&9 9
iodine) iodine)
I"!ortnt in )ro*th nd develo!"ent6 I"!ortnt in )ro*th nd develo!"ent6
re)ulte ener)y "et$olis"6 "intin $ody re)ulte ener)y "et$olis"6 "intin $ody
te"!erture te"!erture
,, ,,, , +alcitonin +alcitonin0 i"!ortnt in re)ultin) 0 i"!ortnt in re)ultin)
clciu" "et$olis" clciu" "et$olis"
!ffects of Th%roid Hormones !ffects of Th%roid Hormones
%ro*th nd Develo!"ent %ro*th nd Develo!"ent
Clori)enic Clori)enic '##ects '##ects
Crdiovsculr '##ects Crdiovsculr '##ects
Met$olic '##ects Met$olic '##ects
'ro(th and De&elo"ment 'ro(th and De&elo"ment
Thyroid hor"one (TH) Thyroid hor"one (TH)
re)ultes re)ultes
o!ti"l o!ti"l )ro*th nd )ro*th nd
develo!"ent o# ll $ody tissue6 develo!"ent o# ll $ody tissue6
sti"ultes sti"ultes protein protein synthesis synthesis
!resu"$ly $y incresin) D<A !resu"$ly $y incresin) D<A
trnscri!tion6 trnscri!tion6
TH TH criticl #or nervous, skeletl criticl #or nervous, skeletl
nd re!roductive tissues nd re!roductive tissues
Butterfly is the symbol of thyroid cancer survivors
nd re!roductive tissues nd re!roductive tissues
+retinism: +retinism: due to de#iciency in due to de#iciency in
iodine iodine6 #ilure o# thyroid to develo!6 6 #ilure o# thyroid to develo!6
dwarfism dwarfism; ;
also also- - "entl retrdtion, !le skin, "entl retrdtion, !le skin,
slo* hert rte, lo* $ody slo* hert rte, lo* $ody te"!erture te"!erture
nor"l nor"l develo!"ent re=uires erly develo!"ent re=uires erly
di)nosis nd tret"ent di)nosis nd tret"ent
Butterfly is the symbol of thyroid cancer survivors
Calorigenic !ffect
Thyroid hor"ones increse Thyroid hor"ones increse
restin) or $sl "et$olic rte restin) or $sl "et$olic rte
o# *hole or)nis" o# *hole or)nis"
Most sensitive tissues0 hert, Most sensitive tissues0 hert,
skeletl "uscle, liver, kidneys skeletl "uscle, liver, kidneys
Thyroid hor"ones increse Thyroid hor"ones increse
$ody te"!erture $ody te"!erture $ody te"!erture $ody te"!erture
Altertions in $ody Altertions in $ody
te"!erture re)ulte TH te"!erture re)ulte TH
!roduction !roduction
Cold Incresed T Cold Incresed T
77
nd T nd T
: :
!roduction !roduction

Cardio&ascular !ffects
Thyroid Thyroid hor"ones0 hor"ones0
increse increse hert hert rte rte
increse increse #orce o# #orce o#
contrction contrction
incresed incresed crdic crdic
out!ut out!ut
"echanism "echanism0 0 "echanism "echanism0 0
Direct Direct effect effect0 $indin) 0 $indin)
to thyroid hor"one to thyroid hor"one
rece!tors in hert6 not rece!tors in hert6 not
>ust res!onse to >ust res!onse to
increse in $sl increse in $sl
"et$olis" "et$olis"
,ndirect ,ndirect effect effect0 0
Incresed nu"$er o# Incresed nu"$er o#
$et drener)ic $et drener)ic
rece!tors in hert rece!tors in hert
Metabolic !ffects
Sti"ulte "et$olis" Sti"ulte "et$olis"
o# cholesterol to $ile o# cholesterol to $ile
cids cids
Increse $indin) o# Increse $indin) o#
LDL $y liver LDL $y liver
Increse cr$ohydrte Increse cr$ohydrte
"et$olis" "et$olis"
Increse )lucose Increse )lucose Increse )lucose Increse )lucose
u!tke u!tke
Pituitar% Pituitar%- -H%"othalamus H%"othalamus
Hy!othl"us Hy!othl"us
Anterior Pituitry Anterior Pituitry
TRH
(-)
(-)
Thyroid Thyroid
T: nd T7 T: nd T7
TSH
Thyroid hormones
T3H 5 thyroid-relese
hor"one
Secreted $y
hy!othl"us
2inds to sites in the
nterior !ituitry nterior !ituitry
TSH 5 thyroid-
sti"ultin) hor"one 5
Thyrotro!in
Secreted $y the nterior
!ituitry
%lyco!rotein hor"one
Th%roid $egulation Th%roid $egulation
Autoregulation Autoregulation
Autore)ultion Autore)ultion 55 re)ultion o# the re)ultion o# the
thyroid )lnd *ithout e.ternl si)nlin) thyroid )lnd *ithout e.ternl si)nlin)
Incresed iodine decresed iodide Incresed iodine decresed iodide
u!tke u!tke nd nd or)ni#iction or)ni#iction (conversion (conversion
to iodine) to iodine)
Abnormal stimulators Abnormal stimulators Abnormal stimulators Abnormal stimulators
8raves disease 8raves disease0 0
!roduction !roduction o# thyroid sti"ultin) o# thyroid sti"ultin)
i""uno)lo$ulin i""uno)lo$ulin (nti$ody) $y ly"!hocytes6 (nti$ody) $y ly"!hocytes6
"i"ics "i"ics ction o# TSH6 ction o# TSH6
lon)er lon)er durtion ction6 durtion ction6
utoi""une utoi""une disese disese
Tumors Tumors0 0
thyroto.icosis thyroto.icosis- -
e.cessive e.cessive hor"one !roduction hor"one !roduction
Th%roid H%"erfunction Th%roid H%"erfunction
)igns and )%m"toms )igns and )%m"toms
Incresed $ody te"!erture Incresed $ody te"!erture
Incresed "otor ctivity Incresed "otor ctivity
Incresed sy"!thetic nervous Incresed sy"!thetic nervous
syste" ctivity syste" ctivity
Skin Skin- - #lushed, *r" #lushed, *r"
?ek "uscles6 #ti)ue ?ek "uscles6 #ti)ue ?ek "uscles6 #ti)ue ?ek "uscles6 #ti)ue
Incresed hert rte6 rrhyth"is6 Incresed hert rte6 rrhyth"is6
CH@ CH@
Incresed !!etite Incresed !!etite
<ervousness6 >ittery <ervousness6 >ittery
Incresed $sl "et$olic rte6 Incresed $sl "et$olic rte6
decresed cholesterol nd decresed cholesterol nd
tri)lycerides tri)lycerides
Menstrul irre)ulrities6 decresed Menstrul irre)ulrities6 decresed
#ertility #ertility
Th%roid H%"erfunction
&$cessive secretion &$cessive secretion
thyroid hormones thyroid hormones
8raves Disease 8raves Disease 66 Diffuse To$ic Diffuse To$ic
8oiter 8oiter
the "ost co""on hy!erthyroid the "ost co""on hy!erthyroid
cuse cuse
I)% I)%nti$odies to TSH rece!tors nti$odies to TSH rece!tors- -
ctivte rece!tors ctivte rece!tors
incresed T incresed T nd T nd T relese relese incresed T incresed T
77
nd T nd T
::
relese relese
Chrcteri(ed $y Chrcteri(ed $y thyroto.icosis thyroto.icosis
nd nd o!thl"yo!thy o!thl"yo!thy
Most co""on in youn), "iddle Most co""on in youn), "iddle
)e #e"les (A0- over "en) )e #e"les (A0- over "en)
Autoi""une disese Autoi""une disese
Anti$odies $ind to nd Anti$odies $ind to nd
ctivte TSH rece!tors t the ctivte TSH rece!tors t the
thyroid thyroid
Cn lso $e cused $y )enetic Cn lso $e cused $y )enetic
de#ect in TSH, cusin) de#ect in TSH, cusin)
overe.!ression overe.!ression o# TSH nd o# TSH nd
there#ore incresed thyroid there#ore incresed thyroid
hor"one relese hor"one relese
Graves disease
opthalmyopathy opthalmyopathy
goiter goiter
Th%roid H%"erfunction
&$cessive secretion thyroid &$cessive secretion thyroid
hormones hormones
To$ic 5odular 8oiter To$ic 5odular 8oiter
'PlummerGs Disease* 'PlummerGs Disease*
- - 1ccurs in older !tients 1ccurs in older !tients
- - Arises #ro" lon) Arises #ro" lon)- -stndin) nonto.ic stndin) nonto.ic - - Arises #ro" lon) Arises #ro" lon)- -stndin) nonto.ic stndin) nonto.ic
)oiter )oiter
- - second "ost co""on hy!erthyroid second "ost co""on hy!erthyroid
disese disese
- - one node o# the thyroid "y hve one node o# the thyroid "y hve
$eco"e unre)ulted nd $e)ins to $eco"e unre)ulted nd $e)ins to
relese thyroid hor"one *ithout ny relese thyroid hor"one *ithout ny
control control
Thyroiditis Thyroiditis
66 sometimes leads to sometimes leads to
hyperthyroidism: but usually hyperthyroidism: but usually
resolves on its o4n resolves on its o4n
Treatment of H%"erth%roidism Treatment of H%"erth%roidism
A)ents tht inter#ere *ith A)ents tht inter#ere *ith
!roduction o# T !roduction o# T
77
nd T nd T
::
A)ents tht "odi#y tissue A)ents tht "odi#y tissue
res!onses to T res!onses to T
77
nd T nd T
::
Destruction o# thyroid Destruction o# thyroid Destruction o# thyroid Destruction o# thyroid
)lnd0 )lnd0
sur)ery sur)ery
rdition rdition
Th%roid Th%roid H%"erfunction H%"erfunction Treatment Treatment
Anti Anti- -thyroid dru) thyroid dru)
ther!y ther!y
Thyroidecto"y Thyroidecto"y

-7- -7-
Iodine Iodine
Thyroid Storm Thyroid Storm
((thyroto.ic thyroto.ic crisis) crisis)
li#e thretenin)6 need li#e thretenin)6 need
i""edite tret"ent0 i""edite tret"ent0
propanolol propanolol
Anti-th%roid Hormone Drugs
%oitro)ens %oitro)ens0 )ents tht 0 )ents tht
decrese decrese !roduction !roduction o# o#
TH TH
Thionamides Thionamides Thionamides Thionamides
methima#ole methima#ole
propylthiouracil propylthiouracil
carbima#ole carbima#ole '7H* '7H*
Accu"ulte in thyroid Accu"ulte in thyroid
Anti-th%roid Hormone Drugs
Anion ,nhibitors Anion ,nhibitors
"onovalent "onovalent anions: anions:
rese"$le Iodide6 rese"$le Iodide6
co"!etitive inhi$itors co"!etitive inhi$itors
inhi$it trns!ort o# iodide inhi$it trns!ort o# iodide
into thyroid overco"e $y into thyroid overco"e $y
inhi$it trns!ort o# iodide inhi$it trns!ort o# iodide
into thyroid overco"e $y into thyroid overco"e $y
incresed Iodide incresed Iodide
Perchlorte Perchlorte (Cl1 (Cl1
::
- -
))
Pertechnette Pertechnette (Tc1 (Tc1
::
- -
))
Thiocynte Thiocynte (SC< (SC<
- -
))
Therapeutic use: Therapeutic use:
Diagnostic Diagnostic
Anti-th%roid Hormone Drugs
- - 1ldest re"edy 1ldest re"edy
- - Prdo.icl ction Prdo.icl ction
- - 1$serve e##ects *ithin B: hours 1$serve e##ects *ithin B: hours
- - M.i"u" e##ects0 -+ M.i"u" e##ects0 -+ 55-& dys -& dys
Iodides Iodides
- - M.i"u" e##ects0 -+ M.i"u" e##ects0 -+ 55-& dys -& dys
- - '##ects '##ects te"!orrily te"!orrily
- - Inhi$it TH releseC, inhi$it Inhi$it TH releseC, inhi$it
or)ni#iction or)ni#iction o# iodide o# iodide
- - Decresed si(e nd Decresed si(e nd vsculrity vsculrity o# o#
hy!er!lstic hy!er!lstic )lnd )lnd
- - <o lon)er used lone <o lon)er used lone
((thion"ides thion"ides))
$adioacti&e *odine + $adioacti&e *odine +
,-, ,-,
*. *.
- - 3!idly $sor$ed (orlly) 3!idly $sor$ed (orlly)
- - Concentrted in thyroid Concentrted in thyroid
- - '"its '"its rdition rdition destruction o# destruction o#
thyroid )lnd (!inless) thyroid )lnd (!inless)
- - Short hl# li#e (A d) Short hl# li#e (A d) - - Short hl# li#e (A d) Short hl# li#e (A d)
- - ?idely used to tret hy!erthyroidis" ?idely used to tret hy!erthyroidis"
- - Disdvnt)e0 delyed hy!othyroidis" Disdvnt)e0 delyed hy!othyroidis"
- -Alterntive0 Alterntive0
-B7 -B7
I6 e"its . I6 e"its .- -rys6 rys6
used #or thyroid scns6 hl# li#e D -7 hr used #or thyroid scns6 hl# li#e D -7 hr
*odinated Contrast Media *odinated Contrast Media
I!odte I!odte nd nd
Io!noic Io!noic Acid Acid
- -Inhi$it conversion T Inhi$it conversion T
::

77
T in liver, T in liver, kidney, kidney,
!ituitry nd $rin !ituitry nd $rin
- -Esed in d>unct ther!y Esed in d>unct ther!y
Adrenoce"tor /locking Agents Adrenoce"tor /locking Agents
Mny sy"!to"s o# Mny sy"!to"s o# thyroto.icosis thyroto.icosis
"i"ic sy"!thetic sti"ultion "i"ic sy"!thetic sti"ultion
<eed to use )ents tht r!idly <eed to use )ents tht r!idly
de!lete de!lete ctchol"ines ctchol"ines or or
$lockers $lockers $lockers $lockers
2lock !hysiolo)iclly e##ects o# 2lock !hysiolo)iclly e##ects o#
sy"!thetic nervous syste" sy"!thetic nervous syste"
sti"ultion sti"ultion
8uanethidine 8uanethidine
Propanolol Propanolol
Th%roid H%"ofunction
,nsufficient secretion thyroid hormones ,nsufficient secretion thyroid hormones
Hshi"oto/s Hshi"oto/s Thyroiditis Thyroiditis
Autoi""une Autoi""une thyroiditis thyroiditis 55 the i""une syste" ttcks nd destroys the i""une syste" ttcks nd destroys
!rt o# the thyroid )lnd !rt o# the thyroid )lnd
Medicl tret"ents s cuse #or Medicl tret"ents s cuse #or hy!o#unction hy!o#unction Medicl tret"ents s cuse #or Medicl tret"ents s cuse #or hy!o#unction hy!o#unction
Mny o# the tret"ents #or hy!erthyroidis" cn cuse Mny o# the tret"ents #or hy!erthyroidis" cn cuse
hy!othyroidis" hy!othyroidis"
I-B& tret"ent to destroy !rt o# the thyroid )lnd cn leve not enou)h le#t to I-B& tret"ent to destroy !rt o# the thyroid )lnd cn leve not enou)h le#t to
llo* #or nor"l thyroid #unction llo* #or nor"l thyroid #unction
Sur)icl re"ovl o# tu"ors o# the thyroid Sur)icl re"ovl o# tu"ors o# the thyroid
Prolon)ed )oiter cn d")e the thyroid )lnd Prolon)ed )oiter cn d")e the thyroid )lnd
Th%roid H%"ofunction# Th%roid H%"ofunction#
)igns and )%m"toms )igns and )%m"toms
Ple !u##y skin Ple !u##y skin
Droo!y eyelids Droo!y eyelids
Decresed !eri!herl vsculr Decresed !eri!herl vsculr
resistnce resistnce
Decresed hert rte nd crdic Decresed hert rte nd crdic
out!ut out!ut out!ut out!ut
$rdycrdi $rdycrdi
Decresed !!etite Decresed !!etite
Lethr)y, slo*in) o# "entl !rocesses Lethr)y, slo*in) o# "entl !rocesses
Decresed kidney nd re!roductive Decresed kidney nd re!roductive
#unction (in#ertility) #unction (in#ertility)
Decresed $sl "et$olis" Decresed $sl "et$olis"
Children0 "entl retrdtion, Children0 "entl retrdtion,
d*r#is" d*r#is"
Diagnosis and Treatment of H%"oth%roidism Diagnosis and Treatment of H%"oth%roidism
Diagnosis Diagnosis0 decresed T 0 decresed T
::
!roduction6 !roduction6
ndFor ndFor !resence o# nti !resence o# nti- -thyroid thyroid
nti$ody (utoi""une) nti$ody (utoi""une)
Treatment Treatment00 Treatment Treatment00
3e!lce"ent 3e!lce"ent ther!y *ith ther!y *ith
levothyro$ine levothyro$ine 'T 'T
@ @
**66
St$le St$le, ,
lon) lon) hl# hl#- -li#e (G d), li#e (G d),
converted converted to T to T
77
6 6
used used to tret hy!othyroidis", to tret hy!othyroidis",
"y.ede" "y.ede", co", cretinis", , co", cretinis",
si"!le )oiter, nodulr )oiter si"!le )oiter, nodulr )oiter
Parathyroid gland
S"ll )lnds tht lie $ehind the
thyroid
Hi)hly vsculri(ed nd
continully "onitors the
clciu" concentrtion in the clciu" concentrtion in the
$lood
Prthyroid hor"one 5
@unctions to control clciu" in
the $lood
Indirectly, this i"!cts ho*
"uch clciu" reches the $ones
Parath%roid 'lands
'"$edded in thyroid
Secrete (PTH)
parathyroid hormone
Increses $lood Increses $lood
clciu" levels
Sti"ultes osteoclsts
Pro"otes clciu"
re$sor!tion $y
kidneys
)unctions
"uscle contrction
$one su!!ort
cell si)nlin)
Plasma levels maintained by
Calcium Calcium
Plasma levels maintained by
Diet
2one Hstor)eI
3ecycled
Control of Calcium /alance and Control of Calcium /alance and
Metabolism Metabolism
Prthyroid Hor"one
Clcitrol
Jit"in D
SunFdiet
Clcitonin Clcitonin
Thyroid
Phos!hte $lnce
Diseases of the parathyroid
Hy!er!rthyroid
disorders 5
2ones )ive u! clciu"
to increse $lood
clciu" clciu"
Cn led to osteo!eni
nd osteo!orosis
0steo"orosis# Disease of /one 'ro(th and 0steo"orosis# Disease of /one 'ro(th and
Calcium Metabolism Calcium Metabolism
2one re$sor!tion
e.ceeds de!osition
1steoclsts "o$ili(e
C
BK
to !ls" C to !ls"
@ctors0 inde=ute
C
BK
intke, )enes,
hor"ones, s"okin)
Questions?